In patients with atrial fibrillation (AF) who have a low risk for stroke, the anticoagulant apixaban was found to reduce the risk for stroke and increase life expectancy at a higher rate than aspirin and provided cost-effective clinical benefits, according to research published in Stroke: A Journal of Cerebral Circulation.

In the first study to compare the cost-effectiveness of a new oral anticoagulant vs aspirin among low-risk patients, researchers found that apixaban is cost-effective compared with aspirin across low-risk patient subgroups and can offer substantial clinical benefits. These findings support intensified stroke prevention even in patients with a low risk for stroke.

Researchers adapted a previously developed Markov research model to conduct a secondary analysis of the AVERROES study (Apixaban Vs Acetylsalicylic Acid to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) and estimate event rates by treatment in 3 different low-risk cohorts. They assessed stroke risk using the CHADS2 (congestive heart failure, hypertension, age older than 75 years, diabetes mellitus, stroke/transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke/transient ischemic attack, vascular disease) stroke risk classifications.


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Researchers divided 1000 participants into 3 cohorts. The first cohort had a CHADS2 score of 1, the second had a CHA2DS2-VASc score of 1, and the third had a CHA2DS2-VASc score of 2 to 4. They assessed the number of clinical events, including strokes and major bleeds, as well as life years gained, quality-adjusted life years gained, costs, and incremental costs per quality-adjusted life year gained.

Apixaban was associated with 48, 87, and 34 fewer strokes and systemic embolisms compared with aspirin in patients with CHADS2 scores of 1, those with CHA2DS2-VASc scores of 1, and those with CHA2DS2-VASc scores of 2 to 4, respectively. But apixaban was associated with 24, 41, and 18 additional major bleeding events in these patient populations, respectively.